Abstract
Introduction: Integrated care is considered the ultimate solution to overcome fragmentation in support for families with multiple needs. These families experience problems on various life domains that require collaboration between services, including specialized mental health care, primary care, and child protection. In order to organize integrated care, there has been a global trend of reconstructing health care systems. However, despite organizational reforms, providing integrated care in practice remains challenging [1]. Professionals, including psychiatrists, primary care providers, and social workers struggle to implement an integrated approach in their daily practice, leading to inadequate support of families.
Objectives and methods: This participatory research project aimed to study integrated care for families with multiple needs, and thereby contribute to increased understanding of facilitators and barriers for professionals. We conducted a systematic review [2], a qualitative study to unravel the experiences of professionals from multidisciplinary care teams [3], and a qualitative study to deepen our understanding of parental perspectives on barriers and facilitators of providing integrated care [4]. Based on these results, we developed a framework of twelve core components to support professionals in providing integrated care. During the research project, a project team with family representatives, professionals, policy makers and researchers closely collaborated in order to formulate practice-based research questions, and to develop recommendations that fit current practice.
Results: Our results show that professionals should (1) hold a holistic, family-centered focus during care trajectories, (2) be able to recognize the boundaries of one’s own expertise, and (3) timely collaborate with other professionals. Moreover, they should (4) be able to prioritize problems and needs to decide on the focus of support, and (5) organize flexible care provision across domains that is responsive to the needs of families. Also, professionals (6) should feel competent and comfortable to assess a broad range of problems, (7) possess both generalist and specialist knowledge, and (8) ensure adequate application of tools that support integrated care provision. Furthermore, providing integrated care requires (9) preconditions such as time, funding streams and available support, (10) applying different forms of integrated care, and (11) familiarity with other services. Lastly, professionals should (12) frequently evaluate and reflect on care processes.
Conclusion: Given the high correspondence between findings of the systematic review, parental perspectives and professional experiences, we recommend to always consider the twelve core components when developing integrated care initiatives for families. Moreover, the multitude of components related to integrated care provision poses the questions whether integrated care should be an area of expertise in itself.
Implications
The increased understanding of integrated care on a professional level contributes to guide professionals, organizations, and policy makers in improving high-quality and sustainable integrated care initiatives in practice. Since developing integrated care is a dynamic process, frequent evaluation guided by the twelve components is crucial, by all stakeholders involved.
[1] Goodwin N., 2013
[2] Nooteboom, L. et al, 2020a
[3] Nooteboom, L. et al, 2020b
[4] Nooteboom, L. et al., 2020c